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Aortic syndromes are dangerous and a new study examined how often these syndromes were misdiagnosed prior to transfer to other facilities.

There are a host of aortic syndromes that demand rapid medical attention.  A new study published in the Journal of the American Heart Association (JAHA) evaluated two aortic center databases to learn how often misdiagnosis occurred prior to transfer to an acute aortic care facility.  The study looked at diagnosis involving aortic dissection (a tear in the aorta, the main artery in the human body), intramural hematoma (blood leaking through the aortic wall), penetrating aortic ulcer (aortic wall abrasion caused by plaque build-up), and aortic pseudoaneurysm (a bulge or tear in the inside layer of the aorta caused by trauma or surgical complication).  Aortic emergencies can quickly cause death if misdiagnosed.  This study looked at the data of patients who presented to facilities which then transferred patients suspected of an aortic syndrome to a higher-level care facility.

Researchers looked at 3772 patient transfers following diagnosis and found 1762 of those patients were emergency transfers for an aortic syndrome. Findings of the study include:

  • Approximately 58 percent of the patients were male with a mean age of 64 years.
  • The study involved transfers from 203 medical centers by air (49 percent) and ground (51 percent).
  • Misdiagnosis—or the difference between the initial diagnosis and the actual diagnosis—occurred in 10 percent of cases.
  • There are two types of aortic dissection—type A and type B.  Type A dissections occur as the aorta exits the heart and are more deadly and common than type B dissections.  Type B dissections occur in the descending aorta which leads into the abdomen. The study found type A and type B dissections were incorrectly classified in 23 percent of patients.
  • Approximately 30 percent of patients diagnosed with acute aortic dissection did not actually have one. 
  • Of those transferred with a diagnosis of impending aortic rupture, 14 percent were not eventually diagnosed with a potential rupture.

Given the potentially fast and fatal consequence of an aortic syndrome, a certain number of misdiagnoses will occur in service to the health and life of the patient. That said, study authors point out the time and effort to mobilize an aortic team is considerable—especially when the team might be serving another patient who is on the brink of death. Correct evaluation of imaging studies is critical as well.

Accurate and timely diagnosis is always the ideal but—unfortunately—it is not always the case.

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